Provider Demographics
NPI:1619400157
Name:BAH, MAMADOU MOUCTAR (PA)
Entity type:Individual
Prefix:MR
First Name:MAMADOU
Middle Name:MOUCTAR
Last Name:BAH
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Gender:M
Credentials:PA
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Mailing Address - Street 1:749 MIDDLETOWN WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9095
Mailing Address - Country:US
Mailing Address - Phone:302-273-1614
Mailing Address - Fax:
Practice Address - Street 1:200 HYGEIA DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2049
Practice Address - Country:US
Practice Address - Phone:302-273-1701
Practice Address - Fax:302-273-4497
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2025-08-06
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Provider Licenses
StateLicense IDTaxonomies
MDC0009253363A00000X
NY020752-1363A00000X
DEC5-0012025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant